Baby Teeth Extractions

Should A Deciduous (Baby) Tooth Be Extracted?

There are numerous indications for the extraction of a baby tooth. The choice to extract, restore, or not treat is a very common decision that both dentists and patients have to make every day. In children the decision making process may be straightforward or difficult.  In situations where the offending tooth is not restorable and causing infection and pain, the decision can easily be made.  A tooth that is severely fractured due to trauma may be indicated for extraction. In other, less obvious situations, other factors must be considered.

Tips to Prevent Baby Tooth Extractions

Clearly, the best way of managing advanced decay in a tooth is to prevent the decay in the first place. Effective daily brushing of teeth and home care, regular dental examinations, and controlling the intake of processed sugars are important in that regard. Extraction may be indicated when the decay is so widespread that the tooth cannot be repaired with a dental restoration. The extraction of a deciduous tooth may be unavoidable when the decay has lead to infection and the formation of an abscess at the root of the tooth.

Other Reasons To Remove A Baby Tooth

• A child’s age is important in the decision process. The child’s ability to cooperate during the treatment process must be accessed. Significant cooperation is needed from children if they are required to undergo lengthy treatments like restoring a tooth with advanced decay or even a pulpotomy (deciduous tooth root canal). Lastly, the effect of invasive dental procedures at a young age may affect how an individual will tolerate later dental procedures. This may negatively change the perceptions of a child concerning dental procedures and make future non-invasive dental procedures more difficult.

• Orthodontic treatment for malocclusion may be an indication for the extraction of baby teeth. Dental crowding in the pediatric patient may be an indication for early extraction. Strategically planned (serial) extractions can create space for permanent teeth to erupt into proper alignment.  Performing these extractions may avoid the need for complicated orthodontic treatment later.

• The timing before natural exfoliation must be considered. Delayed exfoliation (natural loss of a baby tooth) may have consequences that affect the eruption of permanent teeth and the timing of orthodontic treatment. It may be possible to determine the amount of time left for a deciduous tooth to naturally exfoliate, or come out naturally. Ages of exfoliation vary from child to child and should be taken into consideration. Some children tend to exfoliate their teeth earlier or later than others. If the determination is made that the permanent tooth needs only a few months or less to erupt, then allowing for natural exfoliation of the deciduous tooth may be indicated.

What Are the signs of Infection or Injury to Baby Teeth?

• Pain is the most common sign of a problem with a tooth. The pain can be spontaneous and intermittent. It may be severe if an abscess develops and then improve if the abscess drains on its own. If the pain goes away it is not an indication that the condition has resolved. This is how the body deals with infections. The problem still remains. This infection could still affect the growth and appearance of the developing permanent tooth below as well as the child’s overall health.

• Bleeding and swelling are other signs of injury or infection. There may be swelling or a “pimple” or bump on the gums. The crown of the tooth may be chipped, cracked or completely severed. Pain can vary according to the extent of the damage to the tooth, but there can occasionally be no pain. Biting or chewing may be painful and very young children may resist eating. As a result of a chronic infection the developing permanent tooth below the baby may erupt malformed or discolored. The fate of the developing permanent tooth is always given priority in these cases.

• Mobility and color changes should be evaluated. A tooth loosened by injury may need to be extracted. Baby teeth that have been subjected to trauma, but do not show acute signs of infection or necrosis should be observed over time. Brown, black, or grey discoloration may be an indication of necrosis because of compromise of the nerve or blood supply of the tooth. This results from breakdown of blood cells in the tooth. Teeth exhibiting these signs might be considered for extraction.

Can the Extraction of Baby Teeth Lead to Problems?

Most children adapt surprisingly well to the extraction of baby teeth. Premature loss of baby teeth can result in malocclusion or crowding of the adult dentition. The extraction of baby teeth, especially posterior teeth, allows the permanent teeth to drift forward into the extraction space.  This narrows the space in the jaw and may affect the normal eruption of other permanent teeth. Orthodontic treatment of this crowding in order to re-align or straighten these teeth may be necessary to allow for the normal eruption of the other permanent teeth. After extraction, a space maintaining device can be made by the child’s dentist to prevent the drifting of those permanent teeth.